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Transparency

Supplying transparent information on the most affordable and clinically effective drugs for each patient enhances patient care and improves quality.

Transparency that helps patients and payers is necessary across the entire prescription drug chain. PBMs do their part to support and practice transparency. However, the drug manufacturers, who alone set the drug prices, do not.

PBMs: TRANSPARENCY FOR PATIENTS AND PAYERS

PBMs practice transparency that empowers patients, their providers, plan sponsors, and policymakers, so that there is informed decision-making that can lead to lower prescription drug costs. They include:

Providing real-time benefits tools, so physicians and patients know, at the point of prescribing, what drugs are on formulary and patient’s cost-sharing.

Providing information to clients on all contract terms, including how PBMs are paid for their services and negotiated rebates.

Providing government regulators, such as CMS for Medicare Part D, information on price concessions, costs, and service fees.

The Right Transparency on Prescription Drug Costs

Transparency that Increases Drug Costs

  • Specific price concessions that allow drugmakers to realize they can discount less.
  • Requiring public disclosure of proprietary, competitively sensitive information.
  • Data that allows drug companies or drugstores to tacitly collude with the competition

Transparency that Reduces Drug Costs

Information for patients:

  • Premiums, cost sharing for drugs in their health plan, and their out-of-pocket maximum cost.

  • What drugs are covered and on what formulary tier.

  • What pharmacies are in the network.

  • Expected annual out-of-pocket costs for their prescription.

Information for employers, unions, and other health plan sponsors:

  • Financial information about rebates, fees and payments, as outlined in the PBM-plan sponsor contract.

  • Whether the PBM is living up to its contract, through audits by the health plan.

  • How much they will pay for each prescription filled by an enrollee in their plan.

  • Aggregate data on drug utilization by plan enrollees.

  • Drug safety information.

Information for physicians:

  • The plan’s utilization management requirements, including for prior authorization and step therapy, and how to meet them.

  • The patient’s formulary and cost sharing in real time.

Transparency that Reduces Drug Costs versus Transparency that Raises Them.

PBMs support and practice transparency that empowers patients, their providers, plan sponsors, and policymakers, so that there is informed decision-making that can lead to lower prescription drug costs. What we don’t support are measures that would empower drug companies to raise costs.

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